Unum Group Life and AD&D Employee Certificate Booklet

Accidental Death and Dismemberment Details

The information in this section provides details about the benefits that may be payable, and any applicable Exclusions and Limitations included in an Insured`s coverage. Benefits will only be payable for an Insured's Covered Loss resulting from Injuries sustained in an Accident that occurs on or after the Insured's Coverage Effective Date. Accidental Death and Dismemberment Benefits The most we will pay for any combination of Covered Losses from any one Accident is 100% of an Insured's AD&D Benefit Amount. Accidental Death Benefit Benefit Description We will pay the corresponding amount shown in the Schedule of Benefits if, due to Injuries sustained in an Accident, an Insured dies. The Accidental Death must be within 365 days of the Accident. Benefit Duration This benefit is payable once per Insured. Accidental Benefit Description We will pay the corresponding amount shown in the Schedule of Benefits if, due to Injuries sustained in an Accident, an Insured suffers an Accidental Dismemberment and Loss of Use. The Accidental Dismemberment and Loss of Use must occur within 365 days from the date of the Accident. For purposes of this benefit, the following meet the Benefit Description of Accidental Dismemberment and Loss of Use: Dismemberment and Loss of Use Benefit

- for the dismemberment of a foot, all of the foot is cut off at or above the ankle joint; - for the dismemberment of a hand, all four fingers are cut off at or above the knuckles joining each to the hand; - for the dismemberment of a thumb and index finger, all of the thumb and index finger are cut off at or above the joint closest to the wrist; - for the dismemberment of all toes on one foot or the big toe on one foot, the toes are cut off at or above the point at which they are attached to the foot; - for the loss of hearing, the ability to hear is a total and irrecoverable loss in both ears; - for the loss of sight in one eye, the eye must be totally blind, and no sight can be restored in that eye; - for the loss of sight in both eyes: - the sight in the better eye is reduced to a best corrected visual acuity of 20/200 or less (Snellen or E-Chart Acuity); or - the sight in the better eye has a visual field that is less than 20°; and - the Insured was not previously legally blind; - for the loss of speech, the ability to speak is a total and irrecoverable loss. If an Insured sustains multiple Accidental Dismemberments and Losses of Use in a single Accident, we will pay for each Accidental Dismemberment and Loss of Use but will pay no more than 100% of the Insured's AD&D Benefit Amount. Benefit Duration This benefit is payable once per Insured per Accident. Benefit Description We will pay the corresponding amount shown in the Schedule of Benefits if, due to Injuries sustained in an Accident, an Insured is in a Coma for a period of 31 or more consecutive days. A Physician must confirm the Coma began within 365 days of the Accident.

Coma Benefit

UA-GTLC21-1

Group Life and Accidental Death and Dismemberment Certificate

(1/1/2025) 14

Unum Life Insurance Company of America

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